project osteoporosis
TRANSCRIPT
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A 60-year-old postmenopausal Caucasian woman is seeing her physician after her annual checkup. She has been in good
general health for the past several years. She experienced menopause in her early 50s and
initiated hormone therapy (HT) with estrogen/ progestin for her menopausal
symptoms; she has remained on HT primarily for prevention of osteoporosis. She is
currently not on any chronic medications other than HT.
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Although the patient has no personal history of fractures, her older sister experienced a hip fracture. She is 5’7” and weighs 112 lbs. She smokes cigarettes, drinks several cups of coffee a day, and rarely exercises. Her height has remained stable over the past 4 years.
Given the publicity surrounding the results of the Women’s Health Initiative (WHI) on
estrogen/progestin and estrogen alone, she expresses concern about the risk/benefit of
her continued use of HT.
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OsteoporosisOsteon (Greek):
BONEPoros (Greek): PORE
(having open spaces
It is a systematic skeletal disorder characterized by compromised bone strength predisposing to an
increased risk of fracture. – Black and Hawks, 2008
Compromised bone strength comprises of two
factors…
‘Fragile Bone Disease’
‘The Silent Disease’
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Low Bone Mineral Density
Cell deterioration outpaces new cell production
BMD refers to the amount of mineral matter per square centimeter of bones.
Osteopeni
a
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Clinical Manifestations
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Dowager’s Hump
Dorsal Kyphosis
Chronic back pain
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Risk factors
A g e
Race
History of Chronic Diseases such as:
History of Previous Fractures
Family HistoryGender
Being Caucasian or Asian in origin
…of maternal osteoporosis, fragility fractures or dowager’s hump
Women lose greater amounts of bone calcium during the first few years after menopause…
…the drop in estrogen levels appears to initiate bone loss1:2 women and 1:5 men over the age of 50 will break a bone mainly because of poor bone health
…particularly low truma or spontaneous fractures…thyroid disease, other bone diseases, metabolic diseases that impair absorption of nutrients
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Risk factors
Caffeine
Chronic Heavy Alcohol Consumption
Sedentary Lifestyle
SmokingNutrition/calcium
intake
Eating less than the recommended calories and intake of calcium
Research show that alcohol appears to reduce bone density…
…it may directly depress bone formation or may take the place of more nutritious foods
Smokers tend to be of lower weight (less bone density) than non smokers
It has been tied to urinary excretion of calcium. Reasonable use of caffeinated drinks, however, may be acceptable.
A physically active lifestyle not only enhances calcium absorption but also helps to maintain bone matrix mineralization…
…however, excessive exercise that results in extremely low body fat levels for women may be detrimental to bone density
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Anatomy and physiology
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Pathophysiology
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Reaching a diagnosis
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DualNe
gy
ayr
bsorptiometr
EXAThe gold
standard for the
diagnosis of
osteoporosis
Two X-ray beams with different energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone.
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Status Hip BMD
Normal T-score of -1 or above
Osteopenia T-score lower than -1 and greater than -2.5
Osteoporosis T-score of -2.5 or lower
Severe osteoporosis T-score of -2.5 or lower, and presence of at least one fragility fracture
WHO has developed general categories to clarify the definition of osteoporosis. The categories include the following:
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COMPUTERIZE
D
TOMOGRAPHY
(CT) SCAN
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Medical Management
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Management of osteoporosis should Be directed to these aspects:
1) Medication Regimen
3) Nutritional / Dietary Changes
2) Lifestyle Changes
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Medications Include:
Calcitonin
Biphosphonates
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Medications Include:
Hormone
Replacemen
t Therapy
Selective Estrogen Receptor Modulators (SERM)
Denosuma
b
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SurgicalManagement
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VERTEBROPLAST
Y
KYPHOPLASTY
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Prognosis
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Although osteoporosis patients have an
increased mortality rate due to the
complications of fracture,
IT IS RARELY LETHAL.
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Prevention
of osteoporosis should be directed to the “reversal” of the modifiable risk factors...
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It’sNEVERTOOearly to
B O N E
inINVEST
HEALTH
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CHILDREN, ADOLESCENT, ADULTS SHOULD:Ensure a dietNUTRITIOUSwith ADEQUATE calcium intake.
Maintain an
VITAMINsupply ofADEQUATE
D.
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CHILDREN, ADOLESCENT, ADULTS SHOULD:Participate in
physicalREGULAR
activity.AVOID and
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Most
abundant99% bones, 1%
in blood
Muscle contraction / relaxation
Nerve
transmission
BP regulation
Factors Favoring Calcium Absorption
Acidity of
digestive
mass
LactoseSufficien
t Vitamin
D
Body’s need for
higher amounts
(as in pregnancy)
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Sedentary Lifestyle
Laxative use
Excessive Phosphorus
IntakeFactors Hindering Calcium Absorption
Dietary
fat / fiber Aging
Drug Use
Binders such as
phytic and
oxalic acid
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Research